Correlation Of Metrnl Protein Level With GRACE Score And Prognosis In Patients With Acute Myocardial Infarction

Purpose:To explore the correlation between serum Metrnl protein level and GRACE score and occurrence of MACE in patients with acute myocardial infarction(AMI),and to evaluate the value of GRACE score and serum Metrnl in predicting short-term adverse prognosis in patients with AMI.Methods:Seventy patients with acute myocardial infarction(AMI)hospitalized in the department of cardiology from June 2020 to August 2020 were selected,including 54 males and 16 females,and all patients were evaluated with The Global Registry of Acute Coronary Events(GRACE)score.According to GRACE score,they were divided into low-risk group(<108 points),medium-risk group(108-140 points),and high-risk group(>140 points).Seventy subjects,including 46 males and 24 females from physical examination center in our hospital,were selected as the healthy control group.Serum Metrnl concentration was detected by ELISA,and clinical data such as blood biochemical data were collected.Major Adverse Cardiac Events(MACE)during hospitalization of AMI patients were observed.All survivors of AMI were followed up for the occurrence of MACE after discharge,and the follow-up time was 6 months or until the occurrence of outcome events.Subjects were grouped according to whether they had MACE during hospitalization and short-term follow-up.Analyze the correlation between the level of Metrnl protein in circulation and GRACE score in patients with AMI and its predictive value for short-term prognosis of patients with myocardial infarction.Results:1.A total of 140 subjects were included in this study,which were divided into AMI group(70 cases)and healthy control group(70 cases)according to whether they were diagnosed with AMI.There were no statistically significant differences in gender,TG,HDL-C,creatinine,uric acid and other indicators between the two groups.There were significant differences in age,FPG,TC,LDL-C,ALT,AST,BUN and Metrnl(P<0.05).ROC curve analysis showed that the area under the curve for Metrnl to predict AMI was 0.745,the best cutoff value was 127.36,the sensitivity was 72.9%,the specificity was 71.4%,and 95%CI(0.663～0.828).2.All AMI patients were divided into low-risk group,medium-risk group and high-risk group according to GRACE score.There were differences in age,combined arrhythmia,systolic blood pressure,Apo B,D-dimer,Metrnl,LVEF,in-hospital MACE and short-term MACE among the three subgroups,with statistical significance(P<0.05).Further pair-to-pair comparison between the two groups showed that there were significant differences in age,arrhythmia,Metrnl and in-hospital MACE between the high-risk group and the low-risk group and the medium-risk group,with statistical significance(P<0.05),3.Correlation analysis showed that serum Metrnl level was negatively correlated with GRACE score(r=-0.503,P<0.05).Metrnl level was inversely associated with the risk of MACE in all subjects during short-term follow-up,with correlation coefficients r=-0.461(P<0.001)for in-hospital MACE and r=-0.391(P=0.001)for 6-month follow-up.4.The theresults of univariate logistic regression showed that there was a significant difference in Metrnl between the MACE group and the non-MACE group in the hospital,with statistical significance(P<0.05).Further analysis of multivariate Logistic regression showed no statistical significance in Metrnl.By drawing ROC curve analysis,the area under ROC curve for Metrnl to predict MACE in the hospital was 0.786,and the optimal cut-off point value was 121.39.At this time,the sensitivity and specificity were 70.8%,81.8%,and 95%CI(0.673～0.900).The analysis of univariate Cox regression analysis showed that the level of Metrnl in MACE group was significantly lower than that in non-MACE group,with statistical significance(P<0.05).In multivariate Cox regression analysis,although there were differences in Metrnl levels between the two groups,there was no statistical significance.To analyze the predictive value of serum Metrnl level in the short-term prognosis of AMI patients,the area under the ROC curve was 0.767,and the optimal cut-off point value was 118.87,the sensitivity was 77.4%,the specificity was 62.5%,and 95%CI(0.627-0.908).Conclusion:1.Serum Metrnl level in AMI patients is lower than that in normal subjects,and is negatively correlated with GRACE score.2.Metrnl is negatively correlated with MACE in patients with AMI during hospitalization and 6month follow-up after discharge,suggesting a certain predictive value for short-term prognosis,which is expected to provide a new biological reference marker for clinical evaluation of risk stratification and prognosis in patients with myocardial infarction.